title: Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis.
abstract: Femoroacetabular impingement due to metaphyseal prominence is associated with the slippage in patients with slipped capital femoral epiphysis (SCFE), but it is unclear whether the changes in femoral metaphysis morphology are associated with range of motion (ROM) changes or type of impingement. We asked whether the femoral head-neck junction morphology influences ROM analysis and type of impingement in addition to the slip angle and the acetabular version. We analyzed in 31 patients with SCFE the relationship between the proximal femoral morphology and limitation in ROM due to impingement based on simulated ROM of preoperative CT data. The ROM was analyzed in relation to degree of slippage, femoral metaphysis morphology, acetabular version, and pathomechanical terms of "impaction" and "inclusion." The ROM in the affected hips was comparable to that in the unaffected hips for mild slippage and decreased for slippage of more than 30 degrees. The limitation correlated with changes in the metaphysic morphology and changed acetabular version. Decreased head-neck offset in hips with slip angles between 30 degrees and 50 degrees had restricted ROM to nearly the same degree as in severe SCFE. Therefore, in addition to the slip angle, the femoral metaphysis morphology should be used as criteria for reconstructive surgery.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University Bern, Freiburgstrasse, 3010, Bern, Switzerland. mamisch@bwh.harvard.edu
authors.forename: Tallal C
authors.initials: TC
authors.lastname: Mamisch
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jens A
authors.initials: JA
authors.lastname: Richolt
authors.forename: Michael B
authors.initials: MB
authors.lastname: Millis
authors.forename: Jens
authors.initials: J
authors.lastname: Kordelle
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000293:Adolescent; D002648:Child; D003198:Computer Simulation; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005272:Femur Neck / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed